Growth & development of face/certified fixed orthodontic courses by Indian dental academy

CONTENTSCONTENTS
 INTRODUCTION
 EARLY EMBRYONIC DEVELOPMENT
 DEVELOPMENT OF FACE
 DEVELOPMENT OF BRANCHIAL ARCHES
 DEVELOPMENTAL ANOMALIES AND
CRANIOFACIAL ANOMALIES OF GENETIC ORIGIN
 GROWTH OF FACE
 ANATOMY OF FACE
 PROSTHODONTIC CONSIDERATIONS
 SUMMARY AND CONCLUSION
 REFERENCES
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

“A KNOWLEDGE OF DEVELOPMENT IS
A PRECIOUS KEY TO A GRASP OF THE
ANATOMICAL FINISHED PRODUCTS.
ALTHOUGH THIS PRINCIPLE HOLDS
FOR ALL PARTS OF THE BODY ,IT IS
PROBABLY TRUE TO SAY THAT IT IS
MOST VALID FOR THE HEAD AND
NECK.”

INTRODUCTIONINTRODUCTION
An individual spends 9 months/ 38
weeks/266 days or nearly 383040minutes of
his life in his mother’s womb. Human
development is a continuous process and
does not stop at birth.
Anatomical structures are more diverse in
the mouth than in any other region.

 The development of the dentofacial
complex is dependent primarily upon the
following:
1. Genetic endowment.
2. Environmental factors.
3. Functional forces.

DEFINITION OFDEFINITION OF
DEVELOPEMENTDEVELOPEMENT
•Development refers to all the naturally occuring
unidirectional changes in the life of an individual from its
existence as a single cell to its elobaration as a
multifunctional unit terminating in death. Thus it
encompasses the normal sequential events between
fertilization and death.

EARLY EMBRYONIC DEVELOPMENTEARLY EMBRYONIC DEVELOPMENT
a) Preimplantation period (first 7 days).
b) Embryonic period (next 7 weeks).
c) Fetal period (next 7 months).

PREIMPLANTAION PERIODPREIMPLANTAION PERIOD

PERIOD OF EMBRYOPERIOD OF EMBRYO
It’s divided into 3 periods they
are:
1) PRESOMITE(8-21days)
2) SOMITE(21-31days)
3) POSTSOMITE(32-56days)

FORMATION OF GERM LAYERSFORMATION OF GERM LAYERS
There are three germ layers in the
human embryo:
•Ectoderm
•Endoderm
•Mesoderm

Primitive streak

Primitive streak showing migration of the cells(mesodermal)

Fetal periodFetal period
Last 7 months of fetal life are devoted to
very rapid growth and repositioning of body
components, with little further
organogenesis or tissue differentiation.
- By 3rd
month sex of fetus is known
- 4 months human face is seen
- Last 2 months of fetal life fat is deposited
subcutaneously.

FORMATION OF PHARYNGEAL ARCHES
Pharyngeal arches

DEVELOPMENT OF BRANCHIALDEVELOPMENT OF BRANCHIAL
ARCHESARCHES
 During the 4th
week of i.u. the mesoderm of foregut
region becomes segmented to form a series of five
distinct bilateral mesenchymal swellings the
branchial arches.
 The neural crest tissue surrounds the mesodermal
core.
Skeletal and connective tissue muscle myoblast

• Cartilage component :
Adapt to form Bony, Cartilagenous or
Ligamentous structures
• Muscle component :
Give rise to special visceral muscles
composed of straited muscle fibers.
• Vascular component :
Provides necessary blood supply
Branchial arches

• Enter mesoderm of branchial arches
• Initiate muscle development in the mesoderm
• Nerve component
Branchial arches

1st
BRANCHIAL ARCH
(Mandibular arch)
Branchial arches
• Precursor of both the jaws:
Maxilla + Mandible
• Initially gives rise to a large mandibular
prominence.
• Gives rise to a small maxillary prominence
which extends cranioventrally
Maxillawww.indiandentalacademy.com

COMPONENTS OF 1st
ARCH
Cartilage : MECKEL’S
CARTILAGE
--Arises 41st
– 45th
Day I.U
--It provides a template for
subsequent development of the
mandible.
Branchial arches

Derivatives of Meckel’s Cartilage
-- Mental Ossicle (Endochondral Oss.)
-- Head and neck of Malleus.
-- Short crus of the Incus.
-- Ant. Ligament of the Malleus.
-- Sphenomandibular Ligament
Branchial arches

2. Musculature Derived from 1st
arch:
-- Muscles of Mastication.
-- Mylohyoid Muscle.
-- Ant. Belly of Digastric.
-- Tensor Tympani.
-- Tensor Veli Palatini Muscles.
3. Arterial Component:
-- Part of Maxillary and Ext.Carotid.Art
Branchial arches

4. Nerve components:
-- Mandibular division of Trigeminal.N
( Vth Cranial Nerve)
-- Sensory component supplies
: Mandible and covering mucosa.
: Mandibular teeth including Gingiva.
: Mucosa of ant. 2/3 of Tongue.
: Floor of the mouth.
: Skin of the lower third of Face
Branchial arches

22ndnd
BRANCHIAL ARCHBRANCHIAL ARCH (Hyoid Arch)
•Components:
1. Cartilage : Reichert’s Cartilage
(45th
– 48th
I.U)
-- Greater part of the third ear ossicle.
-- Stapes .
-- Styloid process of the temporal bone.
-- Stylohyoid ligament.
-- Lesser horn and
-- Cranial part - Body of Hyoid.
-- Segments of the facial canal.
Branchial arches

2. Muscles :
-- Stapedius
-- Stylohyoid
-- Post. Belly of Digastric.
-- Muscles of facial expression.
-- Levator Veli Palatini.
Branchial arches

3. Nerve :
-- Facial / VII Cranial nerve.
-- Special sensory component
- Chorda tympani nerve
(Ant 2/3rd
of Tongue)
4. Artery :
-- Stapedial artery
- Transient i.e. disappears during fetal life.
Branchial arches

•Pharyngeal arch I
•Cranial nerve - Maxillary and mandibular division of
trigeminal nerve (cranial nerve V)
•Artery - Maxillary (terminal branch)
•Muscles - Muscles of mastication (ie, temporalis,
masseter, pterygoids), mylohyoid, anterior belly of digastric,
tensor tympani, tensor veli palatini
•Skeleton - Maxillary cartilage (incus, alisphenoid),
mandibular or Meckel cartilage (malleus), arch dermal
mesenchyme (maxilla, zygomatic, squamous portion of
temporal bone, mandible)
A summary of the derivatives of the first and second pharyngeal
(ie, branchial) arches is as follows:

•Pharyngeal arch II (hyoid)
•Facial nerve - Cranial nerve VII
•Artery - Stapedial
•Muscles - Muscles of facial expression (ie, orbicularis
oculi, orbicularis oris, risorius, buccinator, platysma,
auricularis, frontalis), stapedius muscle, posterior belly of
digastric, stylohyoid muscle
•Skeleton - Stapes, styloid process, stylohyoid ligament,
lesser cornu of hyoid, upper part of the body of the hyoid
bone

Anomalies associated with branchial arches
•Deficient development of the branchial arches result in
syndromes according to the arch involved.
•First arch anomalies
- Agnathia
- Microstomia
- Treacher Collins syndrome (mandibular dysostosis)
- Pierre Robin syndrome (micrognathia+cleft palate)
Branchial arches

Pharyngeal pouches and branchialPharyngeal pouches and branchial
groovesgrooves
 Primitive pharynx project a series of pouches
internally between the branchial arches called
pharyngeal pouches.
 Intervening between the branchial arches externally
are branchial grooves

 First branchial groove deepens to form the
external acoustic meatus and the membrane in the
depth of groove forms the tympanic membrane.
 3rd
and 4th
branchial groove may form cervical
sinus.
 Failure to obliterate completely these grooves may
result in branchial fistula or sinus.

1st
pharyngeal pouch
 Ventral portion obliterated by the developing
tongue.
 Dorsal portion deepens as tubotympanic recess to
form auditory tube.
2nd
pharyngeal pouch
 Forms tonsillar fossa and palatine tonsil.
3rd
pharyngeal pouch
 Forms thymus and inferior parathyroid gland.
4th
pharyngeal pouch
 Forms superior parathyroid gland.
5th
pharyngeal pouch
 Forms the ultimobrachial body
Common anomaly is DiGeorge Syndromewww.indiandentalacademy.com

DEVELOPMENT OF FACEDEVELOPMENT OF FACE
Development of face depends upon the
inductive activities of organizing centres
Procencephalic Rhombencephalic
Induces the inner
ear apparatus and
upper third of face
Induces the middle and
external ear apparatus
and the middle and
lower third of face

Oral development in embryo is demarcated
extremely early in life by the appearance of the
prechordal plate
with
Endodermal Thickening forms
Oropharyngeal Membrane

Face develops from 5 prominences that
surround the stomatodeum
- Frontonasal
- Paired maxillary processes.
- Paired mandibular processes.

Frontonasal prominence formed by
proliferation of mesenchyme ventral to the
forebrain. It forms
- Lateral optic diverticula  eyes
- Forehead (between the eyes)
- Nasal placodes

Mesenchyme proliferates around the
placodes producing medial and lateral nasal
prominences
Lateral nasal prominence separated from
maxillary process by nasolacrimal groove

 Fusion of medial nasal prominences and the
maxillary and lateral nasal prominences requires
disintegration of nasal fin.
 Failure of normal disintegration of nasal fin cause
cleft of upper lip and anterior palate.

Midline merging of medial nasal processMidline merging of medial nasal process
Forms:
- Philtrum of upper lip.
- Tip of the nose.
- Primary palate.
Merging of medial nasal and maxillaryMerging of medial nasal and maxillary
processprocess
Continuity of the upper jaw and lip.
Causes separation of nasal pits from stomodeumwww.indiandentalacademy.com

Merging of mandibular process in midlineMerging of mandibular process in midline
Forms lower jaws and lips

DEVELOPMENT OF NOSEDEVELOPMENT OF NOSE
 The nose is a complex of
contributions from:
- Frontal prominence 
The bridge.
- Medial nasal prominence
 Median ridge and tip
- Lateral nasal prominence
 The alae
- The cartilage of nasal
capsule  the septum
and nasal conchae

A summary of the derivatives of the prominences is as follows:
•Frontonasal prominence - Forehead and the dorsum apex of
the nose
•Lateral nasal prominences - Sides (alae) of the nose
•Medial nasal prominences - Nasal septum
•Maxillary prominences - Upper cheek region and most of the
upper lip
•Mandibular prominences - Chin, lower lip, and lower cheek
regions
•Mesenchyme in the facial prominences - Fleshy derivatives
and various bones

Paranasal SinusesParanasal Sinuses
 Paranasal sinuses develop during late fetal life the
remainder develops after birth.
 They form as outgrowths or diverticula of the
walls of the nasal cavities and become air filled
extensions of the nasal cavities in the adjacent
bone.
– Frontal
– Ethmoidal
– Maxillary
– Sphenoidal

Time of development ofTime of development of
paranasal sinusesparanasal sinuses
•Maxillary sinus: Develops at 10
weeks.
•Sphenoidal sinus. At 4 months i.u.
•Ethmoidal sinus. At 4 months i.u.
•Frontal sinus. 3 to 4 months I.U.

 Expand in nasal fossae
by growth of mucous
membrane sacs- primary
pneumatization
 Enlarged by secondary
pneumatization
 Retain communication
with nasal fossae
through ostia

DEVELOPMENT OF PALATEDEVELOPMENT OF PALATE
Palatogenesis begins towards the end of 5th
week and is completed by about 12th
week.
The palate develops from two primordia.
– Primary palate
– Secondary palate

DEVELOPMENT OF THE EARDEVELOPMENT OF THE EAR
Ear consists of 3 anatomical parts:
Internal ear
Middle ear
External ear

External ear:
External acoustic meatus:
– Develops by deepening of
the dorsal end of the 1st
pharyngeal groove
Pinna or Auricle:
– Six mesenchymal hillocks –
Auricular hillocks develop
from the 1st
and 2nd
pharyngeal arch.

Middle ear:
 Develops from the tubotympanic recess i.e. derived
from the 1st
pharyngeal pouch.
 Tympanic cavity- Distal portion of the tubotympanic
recess expands.
 Tympanic membrane: - Ectodermal lining from 1st
pharyngeal groove
-Mesodermal lining from
1st
and 2nd
arch
-Endodermal lining from
tubotympanic recess

Ear ossicles:
1st
bone to attain ultimate size.
Maleus and Incus develop from the 1st
arch.
Stapes develop from 2nd
arch.
Ossification begins in the 16th
week and
continues up to the 25th
week.

Internal Ear:
•Otic
Placode
•Otic Pit
•Otic
Vesicle
•Primordium for Membrane
labyrinth

•Otic vesicle
•Saccular
part
•Utricle
•Semicircular ducts
•Endolymphatic duct
•Saccule
•Cochlear duct
•Otic vesicle
•Articular part

DEVELOPMENT OF EYEDEVELOPMENT OF EYE
 Eyes develop from three sources:
Neuroectoderm of the forebrain retina,optic n.
Surface ectoderm of the headlens
Mesoderm between these layers eye muscle
and vascular tissues
 1st
indication of eye formation is optic sulcus which is
formed in the 4th
week.www.indiandentalacademy.com

•Optic
sulcus
•Optic vesicle
•Lens placode
•Lens pit •Lens vesicle
•Optic cup
•Retina
•Contact surface ectoderm

ANATOMY OF FACEANATOMY OF FACE
SKIN
 Vascular
 Rich in sebaceous and sweat glands
 Laxity facilitates spread of edema
 Elastic and thick due to insertion of muscles.
Wounds tend to gape

Muscles of the Face
 Develop from 2nd
branchial arch and supplied by
facial nerve
 Grouped under
1. Ms. of scalp
2. Ms. of the auricle
3. Ms. of the eyelid
4. Ms. of nose
5. Ms. around mouth
6. Ms. of the neck

 Common facial expressions and muscles
producing them-
1. Smiling and laughing- zygomaticus major
2. Sadness- levator labii superioris, levator
anguli oris
3. Grief- depressor anguli oris
4. Anger- dilator naris, depressor septii
5. Frowning- corrugator supercilli, procerus

Nerve supply of faceNerve supply of face

Arteries of faceArteries of face
Veins of faceVeins of face

Danger area of face and lymphaticDanger area of face and lymphatic
drainagedrainage

Growth of FaceGrowth of Face
 Growth usually refers to increase in size or
number (Todd).
 Development is progress towards maturity (Todd).
 Growth is largely an anatomic whereas
development is physiologic.
 Differential growth can be described by
- Scammons curve
- Cephalocaudal gradient

THEORIES OF GROWTHTHEORIES OF GROWTH
1. GENETIC THEORY
2. SUTURAL THEORY
3. CARTILAGENOUS THEORY
4. FUNCTIONAL MATRIX THEORY
5. VAN LIMBORGH’S THEORY
6. ENLOWS EXPANDING MASS PRINCIPLE
7. ENLOWS COUNTERPART PRINCIPLE

Factors Affecting GrowthFactors Affecting Growth
1. Hereditary
2. Nutrition
3. Illness
4. Race
5. Socioeconomic factors
6. Family size
7. Climatic and seasonal affects
8. Psychological disturbances
9. Exercise

Growth patterns in the Dentofacial complexGrowth patterns in the Dentofacial complex
 Growth of nasomaxillary complex.
1. Passive displacement.
2. Growth at sutures.
3. Surface remodelling.

Growth in mandible is seen as a series of
bone remodelling process by the deposition
and resorptive processes.
GROWTH IN MANDIBLEGROWTH IN MANDIBLE

Anomalies of DevelopmentAnomalies of Development
Defects of facial development are the result
of various etiological factors.
The study of these anomalies constitute
teratology.
– Defective brain development
– Acephaly
– Acrania
– Acalvaria
– Holoprosencephaly

Otomandibular Syndrome
- Agnathia
- Synotia
- Micrognathia
- Mandibulofacial dysostosis

 Failure of facial prominences to merge results in
developmental clefts.
1. Oblique facial cleft.
2. Microstomia.
3. Macrostomia.

Cleft lip and Palate
 Cleft lip results from the failure of the maxillary prominence
to unite with the mesial nasal prominences.
 Unilateral or bilateral.

Cleft palate
Unilateral and bilateral cleft palate can be
classified into
– Cleft of the anterior palate
– Clefts of the posterior palate
– Clefts of anterior and posterior palate.

Anomalies of Genetic OriginAnomalies of Genetic Origin
Achondroplasia
Cleidocranial dysostosis
Progeria
Down’s syndrome
Mandibulofacial dysostosis

Maxillofacial prosthodontics focuses on
optimizing the rudimentary functions of
speech and swallowing. Although the
primary goal is the restoration of these
functions but patient esthetics and
mastication is important and also has an
psychological effect on the patient.

Nasal prosthesisNasal prosthesis
Orbital prosthesisOrbital prosthesis
Ear prosthesisEar prosthesis

ObturatorObturator
 An obturator prosthesis
is required for patients
who undergo resection of
the maxilla for various
reasons like neoplasms
Types:
 Surgical obturator.
 Interim obturator.
 Definitive obturator.

Various factors to be considered during
complete denture construction
Lip support.
Lip thickness.
Tone of facial tissues.

Summary & ConclusionSummary & Conclusion
 Development of the vertebrate face is a
dynamic multiple-step process, which starts
with the formation of neural crest cells in the
developing brain and their subsequent
migration to form, together with mesodermal
cells, the facial primordia. Signaling
interactions coordinate the outgrowth of the
facial primordia from buds of undifferentiated
mesenchyme into the intricate series of
bones and cartilage structures that, together
with muscle and other tissues, form the adult
face. www.indiandentalacademy.com

ReferencesReferences
 Keith L. Moore “The developing human”. 4th
edition.
 T.W. Saddler “Langman’s Medical Embryology”.
5th
edition.
 G.H. Sperber “Craniofacial embryology”. 4th
edition.
 Moore, Persuad “Color atlast of clinical
embryology”. 2nd
edition.
 W.R. Proffit “Contemporary orthodontics”. 3rd
edition.
 S.I. Balaji “Orthodontics the art and science”. 2nd
edition.

 A.R. Tencate “Oral histology”. 5th
edition.
 Shafer “A textbook of Oral pathology”. 4th
edition.
 B.D. Chaurasia “Human anatomy Head and neck”.
3rd
edition.
 Snell “Clinical anatomy for medical students”.
 Zarb Bolender “Prosthodontic treatment for
edentulous patients”. 12th
edition.
 Keith F. Thomas “ Prosthetic Rehabilitation”.

THANK YOU

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